Dysphagia in Children

What is dysphagia in children?

Dysphagia means trouble swallowing. This condition happens when food or liquids can’t
pass easily from your child’s mouth, into the throat, down the esophagus, and into
the stomach when swallowing.

What causes dysphagia in a child?

Swallowing happens in 4 stages. Swallowing problems happen when something goes wrong
in one or more of these stages. Dysphagia can be long-term (chronic). Or it may come
on suddenly.

If your child’s swallowing issues start suddenly and your child is normally healthy,
your child may have something stuck in the esophagus. If your child has trouble swallowing
and a fever, it may be because of an infection. Chronic swallowing problems are often
caused by another health problem.

Which children are at risk for dysphagia?

The following health problems make it more likely for a child to have problems swallowing:

Being born prematurely

Cleft lip or cleft palate

Compression of the esophagus by other body parts

Dental problems, such as an overbite

Developmental delays

Diseases that affect how the nerves and muscles work

Eosinophilic esophagitis, an allergic condition that affects the esophagus

Gastroesophageal reflux disease (GERD)

Having a foreign object stuck in the esophagus, such as a coin

Having a tracheostomy, which is an artificial opening in the throat for breathing

Large tongue

Large tonsils

Oral sensitivity or vocal cord irritation, which can happen if the child has been
on a breathing machine (ventilator) for a long time

Problems with how the bones of the skull and the structures in the mouth and throat
form (craniofacial anomalies)

Problems with how the digestive tract forms

Paralysis of the vocal cords

Tumors or masses in the throat

What are the symptoms of dysphagia in a child?

Symptoms can occur a bit differently in each child. They can include:

Arching or stiffening of the body during feedings

Chest congestion after eating or drinking

Coughing or choking when eating or drinking or right after

Drooling

Eating slowly

Feeling like food or liquids are sticking in the throat or esophagus or feeling like
there’s a lump in the throat

Gagging during feeding

Getting respiratory infections often

Having food or liquids come out of the nose during or after a feeding

Trying to swallow one mouthful of food several times

Trouble sucking and swallowing

Spitting up or vomiting often

Irritability or not being alert during feedings

Wet or raspy sounding voice during or after eating

Weight loss

The symptoms of this condition may look like symptoms of other health problems. Make
sure your child sees a healthcare provider for a diagnosis.

How is dysphagia diagnosed in a child?

Your child’s healthcare provider will ask about your child’s health history. Then,
he or she will give your child an exam. The healthcare provider will also ask about
how your child eats and if you notice any problems during feedings.

Your child may need a blood test if the healthcare provider thinks there’s an infection.
Your child may also need an imaging test or other tests. These tests may include the
following:

Barium swallow and upper GI series

Your child is given small amounts of barium to drink. This is a metallic, chalky liquid
that coats the inside of organs. This helps them show up on X-rays better. Your child’s
healthcare provider will take a series of X-rays to see what happens as your child
swallows the liquid.

Endoscopy

In this test, a small, flexible tube (endoscope) is used to look at the inside of
your child’s digestive tract. This tube has a light and a camera lens at the end of
it. During the test, your child may have tissue samples removed from the throat, esophagus,
and stomach. Your child’s healthcare provider will test these samples.

Esophageal manometry

Your child’s healthcare provider will guide a small tube with a pressure gauge through
your child’s mouth and into the esophagus. The pressure gauge checks the pressure
in your child’s esophagus. This can tell how well food moves through your child’s
esophagus. Your child will get medicine to help relax and prevent pain (sedation)
for this test.

Laryngoscopy

Your child’s healthcare provider will place a tube into your child’s throat. This
is done to check if your child’s throat is narrowed or has any other problems. Your
child will be under anesthesia for this test.

How is dysphagia treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is and what’s causing your child’s dysphagia.

Infection or an object in the esophagus

If your child’s swallowing issues start suddenly, your child may have something stuck
in his or her esophagus. If your child has trouble swallowing and a fever, it may
be from an infection. These can both be emergencies. Your child will need medical
help right away.

Chronic dysphagia

If your child has chronic dysphagia or dysphagia caused by a health condition, speech
or occupational therapy may help. Your child will learn exercises and feeding techniques
to swallow better.

Your child may be able to swallow thick fluids and soft foods better than thin liquids.
Your child’s healthcare provider may suggest giving baby foods or pureed foods. Some
babies who had trouble swallowing formula or breastmilk do better when they’re old
enough to eat baby foods.

Dysphagia with GERD

If your child also has GERD, treatment for GERD may help your child swallow better.
When your child’s esophagus and throat aren’t as irritated by acid reflux, they may
work better. GERD may be treated with feeding changes or medicine.

Eosinophilic esophagitis

If your child is diagnosed with this condition, a particular elimination diet is often
tried for treatment. Medicines may also be tried.

Esophageal stricture

Children who have scarring or narrowing of the esophagus may need a test. In this
procedure, your child’s healthcare provider may widen (dilate) his or her esophagus.
Your child will need to be under anesthesia for this. Your child may need to have
this procedure repeated.

What are the possible complications of dysphagia in a child?

This condition can cause aspiration. This happens when food or liquids go into your
child’s windpipe and lungs. This can lead to pneumonia and other serious lung problems.

Children with dysphagia often have trouble eating enough. This can cause poor nutrition.
They may not gain enough weight to grow properly.

Some children with dysphagia will have long-term problems. Some children’s ability
to swallow may not improve much. This is more likely in children who also have other
health problems, such as nerve or muscle issues. Other children may learn to eat and
drink better. Ask your child's healthcare provider about your child’s outlook.

Your child may need to see a team of healthcare providers who specialize in feeding
and swallowing. Your child’s team may include a nutritionist, occupational therapist,
speech therapist, psychologist, gastroenterologist, allergist, and an ear, nose, and
throat (ENT) specialist.